Truth Initiative Grant - (Non-Smoking Initiative)

Post-Survey

WCCS is participating in a smoke-free and tobacco-free community college grant initiative through the Truth Initiative Grant Program. The grant is aimed at involving students, faculty, and staff in an effort to create an awareness of the dangers of smoking and using tobacco products as well as implement a smoke-free and tobacco-free policy at the College. This survey does not necessarily represent the views of Truth Initiative, its staff and or Directors.

Direction: Please complete the form using responses that best represent you or your situation/position:

*
1.WCCS E-mail address:

Other E-mail address:

*
2.Identify factors related to smoking that most concern you. (May select more than one)

Second-hand smoke

Ash tray being set on fire

Use of no-smoking areas

Cigarette littering

Smoker's odor

*
3.Identify yourself:

WCCS Student

High School Student

Faculty Member

Staff Member

Task Force Member

Law Enforcement

Health Care Worker

Other

*
4.Sex:

Male

Female

Transgender

*
5.Race (choose one):

Multi-Race

Pacific Islander

American Indian

Asian

African-American

White

*
6.What is the highest grade of school that you have completed? (Select the response that describes your situation)

8th or less

Some high school

Finished high school or GED

Some college

Associate's Degree

Bachelor's Degree

Advanced College Degree (e.g., Masters, Doctorates)

*
7.Do you smoke or use tobacco products?

Yes

No

*
8.Do you want to quit smoking or stop using tobacco products?

Yes

No

N/A

*
9.What is the one most important reason you want to quit using tobacco? (Select Only One)

Health

Money

Family

Because of factors/information identified in the Truth Initiative Awareness program

Work

Smells Bad

Social Acceptability

Other

N/A

*
10.How would you rate your motivation today to stop using tobacco?

Not motivated at all

Somewhat motivated

Very motivated

N/A

*
11.How many cigarettes do you usually smoke per day?

1-5

6-10

11-15

16-20

20 or more

N/A

*
12.In the past 7 days, I have seen someone using tobacco on campus.

Yes

No

*
13.How concerned are you about the health consequences of second-hand smoke on this campus?

Very Concerned

Somewhat concerned

Not all concerned

Not sure

*
14.If you used tobacco, would you be interested in help to quit?

Yes

No

Maybe

*
15.How did you learn about this awareness program?

Friend

Family Member

Co-worker

Ad in paper Flyer

Internet

School administrator

At sporting event

At a recruiting event

Other

*
16.How much has your motivation to stop using tobacco changed as a result of the Truth Initiative Awareness program?

Not at all

Little

Somewhat

Much

A Great Deal

N/A

*
17.What is one thing that you have learned during this awareness program that will help you stop using tobacco?

Tobacco usage causes death

Tobacco usage has a negative impact on my age group

Tobacco usage is high in may community

Using tobacco products may be considered a gateway drug

Using tobacco will affect my love ones

*
18.What was the most useful part of the awareness program?

Advertisement

Brochures

Reading Materials

Lectures

Pamphlets

Other

*
19.Place an "X" in the box that most closely represents your opinion.